Advanced Prostate Cancer Q&A on VideoTuesday, 1st August 2017

Management of Patients with Advanced Prostate CancerSaturday, 22nd July 2017

The European Association of Urology, via publisher Elsevier B.V., has reported on The Advanced Prostate Cancer Consensus Conference APCCC 2017

BACKGROUND: In advanced prostate cancer (APC), successful drug development as well as advances in imaging and molecular characterisation have resulted in multiple areas where there is lack of evidence or low level of evidence. The Advanced Prostate Cancer Consensus Conference (APCCC) 2017 addressed some of these topics.

OBJECTIVE: To present the report of APCCC 2017.

DESIGN, SETTING, AND PARTICIPANTS: Ten important areas of controversy in APC management were identified: high-risk localised and locally advanced prostate cancer; "oligometastatic" prostate cancer; castration-naïve and castration-resistant prostate cancer; the role of imaging in APC; osteoclast-targeted therapy; molecular characterisation of blood and tissue; genetic counselling/testing; side effects of systemic treatment(s); global access to prostate cancer drugs. A panel of 60 international prostate cancer experts developed the program and the consensus questions.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The panel voted publicly but anonymously on 150 predefined questions, which have been developed following a modified Delphi process.

RESULTS AND LIMITATIONS: Voting is based on panellist opinion, and thus is not based on a standard literature review or meta-analysis. The outcomes of the voting had varying degrees of support, as reflected in the wording of this article, as well as in the detailed voting results recorded in Supplementary data.

CONCLUSIONS: The presented expert voting results can be used for support in areas of management of men with APC where there is no high-level evidence, but individualised treatment decisions should as always be based on all of the data available, including disease extent and location, prior therapies regardless of type, host factors including comorbidities, as well as patient preferences, current and emerging evidence, and logistical and economic constraints. Inclusion of men with APC in clinical trials should be strongly encouraged. Importantly, APCCC 2017 again identified important areas in need of trials specifically designed to address them.

PATIENT SUMMARY: The second Advanced Prostate Cancer Consensus Conference APCCC 2017 did provide a forum for discussion and debates on current treatment options for men with advanced prostate cancer. The aim of the conference is to bring the expertise of world experts to care givers around the world who see less patients with prostate cancer. The conference concluded with a discussion and voting of the expert panel on predefined consensus questions, targeting areas of primary clinical relevance. The results of these expert opinion votes are embedded in the clinical context of current treatment of men with advanced prostate cancer and provide a practical guide to clinicians to assist in the discussions with men with prostate cancer as part of a shared and multidisciplinary decision-making process.

New Diagnostic Blood Test will help target drugs for men with advanced prostate cancerTuesday, 9th May 2017

Tackle Trustee Hugh Gunn was interviewed on ITV this week about a new Diagnostic Blood Test which costs less than £50 and can predict whether patients with advanced prostate cancer are likely to respond to certain drugs and whether they might be better served by alternative therapy.

The blood test identified a particular gene which is resistant to the drug. This test could save the NHS thousands of pounds.

Prostate cancer screening reconsideration by the USPSTF in the USAFriday, 5th May 2017

In 2012 the influential United States Preventive Services Task Force (USPSTF) decreed that there was no value in PSA testing for prostate cancer as the “harms” of screening outweighed the “benefits” in terms of lives saved. This put the USPSTF at loggerheads with most expert American urological opinion but nevertheless resulted in a fall in PSA screening. The USPSTF was heavily criticised for having no prostate cancer specialists on its panel and also for failing to identify black African Americans and men with a family history of prostate cancer as being in special risk categories that require a proactive, informed approach to screening.

Since 2012 the proportion of American men presenting with advanced prostate cancer has risen and as more and more screening trials and advances in clinical practice are reported, the USPSTF’s position has become increasingly isolated.

It is therefore of considerable relief to hear that the USPSTF has drafted recommendations that support “discussion-backed decisions for men aged 55-69 based on clinician-patient discussion” that allow patients to make an informed decision based on up to date trial evidence and advances in clinical practice that have significantly reduced the risks of “over- diagnosis” and “over-treatment”.

It is to be hoped that the UK’s National Screening Committee will similarly move to a more positive stance on screening.

Tackle joins with APPGC to raise awareness of the importance of improving local one-year survival ratesFriday, 28th April 2017

Tackle were pleased to be involved with the All-Party Parliamentary Group on Cancer (APPGC) which has written to all CCGs in England to highlight the important role they have in improving one-year survival rates, and to offer support in helping to achieve this. Read the letter.

We fully support John Baron MP, Chairman of the APPGC who said: “If we are going to improve cancer survival rates, we must improve early diagnosis. By writing to CCGs we hope to further raise awareness of this issue, and encourage them to drive forward improvements so that thousands more people are able to survive cancer.

“We have also written to offer our support as we are conscious that CCGs do not have responsibility for broad national issues, such as the workforce. The APPGC’s summer Parliamentary reception, which recognises the 20 CCGs which have most improved their one-year figures, presents a further opportunity to engage.”

Tackle Prostate Cancer is one of 19 cancer charities working together to campaign and lobby for better treatment and access to drugs. As a coalition, we are trying to have NHS England and NICE reconsider their plan to cap drug treatment costs. One of the actions we have taken is to try and get as many people as possible to sign a petition to stop this proposal. The petition has been developed by Prostate Cancer UK on behalf of all our charities.

We urgently need your help, to persuade NHS England and the National Institute for Health and Care Excellence (NICE) to reconsider plans that threaten to have a devastating impact on men fighting prostate cancer in the future.

What we know

The plans would mean NHS England can indefinitely delay access to any new treatment which doesn’t fit under its proposed cost cap. This means that breakthrough treatments for advanced prostate cancer such as enzalutamide and abiraterone may have been delayed for years, arrived in the NHS too late for the thousands of men whose lives they have extended, or never have arrived at all. We are seriously concerned for the treatments of the future, which is why we need you to sign our petition.

Help us fight for change

Although we recognise the significant financial challenges facing the current system, this is not the solution. NHS England and NICE need to hear this is unacceptable for patients and come up with a proposal that makes sure patients get the drugs and treatments they need, when they need them.

Putting the Patient PerspectiveMonday, 23rd January 2017

A key part of our campaigning is to put the patient perspective.

Keith Cass, Tackle Trustee, has been doing that recently. He was a member of the independent panel reviewing how local health boards in Wales carry out Individual Patient Funding Requests (IPFR). Keith provided the patient perspective. You can read and download the full report here.

Keith's important contribution was recognised in a letter of thanks from Vaughan Gething AM, the Welsh Cabinet Secretary for Health, Well-being and Sport which you can read here.

Merits of PSA TestingFriday, 16th December 2016

Medscape reports that, "although about two fifths of all of physicians (42%)...said they believe the prostate specific antigen (PSA) test is overused, a huge majority (90%) said the benefits of the test always, often, or sometimes outweigh the risks, and many frequently recommend a baseline diagnostic for their male patients".

One oncologist, James Benton, MD, said screening is not the issue. "It is what one does with the information that is the real issue," he said. "Medical bureaucrats should not be the arbiters of decisions to screen or not screen," said Dr Benton, adding, "A man in conjunction with his family and doctor should have an unobstructed right to know if he has a cancer and make an informed decision as to how he will proceed with various treatment options ― from active surveillance, radiation, or surgery."

90% of men receiving curative treatment for prostate cancer say their care was very goodWednesday, 14th December 2016

Ninety percent of men who had surgery or radiotherapy to cure their prostate cancer in the English NHS rated their care as 8 or above on a scale ranging from 0 (“very poor”) to 10 (“very good”) according to the third annual report of the National Prostate Cancer Audit (NPCA) published by the Clinical Effectiveness Unit at the Royal College of Surgeons today. The audit is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit Programme.

Prostate cancer is the most frequently diagnosed cancer in men and the third most common cause of cancer-related mortality in the United Kingdom, with about 40,000 new cases each year resulting in 10,000 deaths. The NPCA audit looks at whether NHS services in England and Wales for men diagnosed with prostate cancer meet recommended standards.

In its third year, the NPCA investigated the care men received following a diagnosis of prostate cancer between April 2014 and March 2015 in the English NHS. The report also contains the first preliminary results for men diagnosed in Wales between April 2015 and October 2015.

The audit found four out of five men reported that their views were taken into account, that they had been involved when decisions about their care were made, and that they were given the contact details of a clinical nurse specialist who would support them through their treatment. These results were based on just over 5,450 responses to a survey that was mailed to all men who had had curative treatment 18 months after their prostate cancer was diagnosed.

The survey also showed that many men reported poor sexual function as a side-effect of their curative treatment. However, urinary incontinence, which is another possible side-effect of the treatment, was reported by most men as a much less severe problem. In response, the audit recommends that all men who have side-effects of prostate cancer treatment should have early and ongoing access to supportive specialist services.

“The National Prostate Cancer Audit demonstrates that men with prostate cancer who have curative treatment report a good experience of the care that they receive.

“It is welcome news that men report that they are involved in the decision- making process with regards to their management. It is also reassuring that the majority of men have access to a specialist nurse who plays an important role when these decisions are being made and later will provide further support after the treatment is completed.”

The audit also demonstrates that in England the percentage of men with locally advanced prostate cancer who undergo curative treatments with surgery and/or radiotherapy continues to rise. This percentage increased from 27% between 2006 and 2008 and 47% between 2010 and 2013 to 61% in men diagnosed between April 2014 and March 2015. The increased use of these therapies in men with locally advanced cancer is in line with national guidelines.

“It is very encouraging to see that the number of men with locally advanced prostate cancer (prostate cancer that has a high risk of spreading but is still potentially curable) who receive curative primary treatment is still going up. We know that in particular healthy older men have the potential of a long-term cancer cure with multimodal curative therapies.”

In Wales, the NPCA commenced one year later than in England. As a consequence of this later start performance indicators reflecting how men with prostate cancer were being treated in the Welsh NHS are not yet available. However, preliminary findings demonstrate that the completeness of the data is excellent which reflects the crucial contribution that clinicians make to the collection of audit data in Wales.

“The high level of completeness of data collection that the Audit received for Welsh patients demonstrates that we have an unrivalled opportunity to evaluate cancer services provided to men with prostate cancer by the Welsh NHS.

“I look forward to seeing the results for key performance indicators that will inform how well the prostate cancer services provided to men diagnosed in Wales meet national guidelines.”

The NPCA is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit Programme in response to the need for better information about the quality of prostate cancer services in England and Wales.

The audit is based in the Clinical Effectiveness Unit (CEU) at the Royal College of Surgeons of England (RCS) and is led by clinical experts from the British Association of Urological Surgeons (BAUS) and the British Uro-Oncology Group (BUG). The National Cancer Registration and Analysis Service (NCRAS) manage the data collection in England and Public Health Wales does the same in Wales.

Thanks to Tackle’s continued effective campaigning, NHS Scotland will now provide Cabazitaxel, a life-extending drug for advanced prostate cancer patients who need it. The drug is predicted to help almost 60 men, it is given when the cancer can’t be controlled by hormones and is taken after treatment with Docetaxel. Tackle’s campaigning has helped improve lives by getting Cabazitaxel back on the Cancer Drugs Fund and for use on NHS in England, as well as six more major approval advances.

Roger Wotton, Chairman of Tackle commented: “This is positive news for men in Scotland who now have the same access as other men in the UK to a life-prolonging treatment that increases their chance to live longer. Any extension of time a man with prostate cancer is able to get back to be with family and friends is highly important. The availability of Cabazitaxel (Jevtana) means men in Scotland now have an alternative effective treatment option. Likewise, physicians now have another effective medicine in their arsenal to treat patients.”

Hugh Gunn, trustee and lead campaigner for Tackle, thanks his own Cabazitaxel treatment for still being alive and well today: “This approval is particularly poignant as Tackle led the campaign and I myself have greatly benefited from accessing Cabazitaxel in England, otherwise I feel I would be very near the end of my life.”

Thousands of prostate cancer survivors affected by erectile dysfunction are being abandoned without adequate support, new Freedom of Information (FOI) data obtained by Prostate Cancer UK has revealed.

Today, the UK’s leading men’s health charity has issued a warning that patchy, insufficient care for erection problems is leaving men across the country with unnecessary long term physical and psychological damage, and is calling on the nation to take action by campaigning for better care in their area.

Erectile dysfunction is a common side effect of prostate cancer treatment, affecting 76% of men who have been treated for the disease but it can often be treated if the right care is available.

However, the results of recent FOI requests issued by Prostate Cancer UKreveal a dramatic post code lottery of support with just 13% of local health commissioners across the UK providing the breadth of treatment and services needed to give men living with this challenging condition the best chance of recovery. These findings are reinforced by the results of a survey of over 500 men with erectile dysfunction after prostate cancer treatment, in which as many as 1 in 4 (24%) men claimed no one offered them support or medication to deal with the issue.

John Robertson, Specialist Nurse at Prostate Cancer UK said; “When it comes to treating erectile dysfunction following prostate cancer treatment, early support and treatment is vital.

“As a specialist nurse, I regularly speak to men at rock bottom because they can no longer get or maintain an erection. Not only can it put a complete stop to a man’s sex life, it can have devastating longer term implications including depression and relationship breakdowns. It is therefore incredibly concerning that only a handful of men are getting the support needed to overcome this condition and it’s shocking that in some areas men aren’t getting any support whatsoever.”

It is the responsibility of commissioners (CCGs in England, Health Boards in Scotland and Wales and Health & Social Care Trusts in Northern Ireland) to bring about change at a local level. In a bid to put a stop to the wide disparity in care, Prostate Cancer UK is calling on the public to put urgent pressure on health funders in the worst performing areas to ensure they are held accountable for improving access to treatments and support.

Recent treatment guidance for erectile dysfunction produced by Prostate Cancer UK and Macmillan Cancer Support recommends early intervention and a choice of five treatment and support options in order to give men the best chance of recovery. Treatment and support should include access to a NHS erectile dysfunction clinic, an appropriate choice of medication including daily low dose tadalafil (Cialis®), vacuum pumps, and access to psychosexual clinics and counselling services. Erectile dysfunction clinics are widely regarded as the most essential service, as they provide support across both physical and emotional needs and help men to understand what they should expect at each stage of their recovery. However, the FOI results revealed that only half (51%) of commissioners could confirm that they offer this as an option. Two commissioners admitted that they offer no support whatsoever and almost 1 in 5 (17%) were completely unaware of the arrangements in their area. 17 commissioners failed to provide satisfactory information for all questions raised in the request.

Robertson continued; “This is an issue that has been swept under the carpet for too long and thousands of men have been left to suffer in silence. Erectile dysfunction is a debilitating health condition and it must be taken seriously by the NHS and commissioning groups. Now is the time to take action – everyone can do their bit to make sure men across the country get access to the vital support they need.”

Brian White from Leeds (42) was diagnosed with prostate cancer at the age of 41. He had an operation to remove his prostate in October 2015.

“My partner and I were made fully aware of the possible side effects – incontinence and erectile dysfunction, but at the time I was so focussed on getting rid of the cancer – the longer term implications didn’t really come into question.

“One year down the line and I’m still in remission but I’m living with the harsh side effects of my treatment. Thankfully my incontinence is much better but I’m still struggling with erections. I’m only 42 and my partner is 36. Sex and intimacy is so important to us, as it is to most relationships and adjusting to a different way of life has been incredibly difficult. The spontaneity of our sexual relationship has gone and now every intimate moment has to be planned well in advance.

“Things are certainly improving but the road to recovery is a long one. I want to make everyone aware that support for erectile problems shouldn’t be a ‘nice to have’ - it’s essential. Before any man undergoes treatment for prostate cancer he needs to be safe in knowledge that there is appropriate care on the other side to help him with the aftermath. The fact that some men don’t get access to any support whatsoever is shocking.”

Members share their prostate cancer stories on BBC BreakfastWednesday, 16th November 2016

A number of our members - beginning with Tackle Chairman Roger Wotton - were shown on BBC Breakfast telling their prostate cancer story in twitter-sized takes. See them here.

The PSA Debate across the pondThursday, 20th October 2016

The debate about PSA testing and national prostate screening programmes continues to be debated around the world. Tackle welcomes thie latest contribution from across the pond which challenges current guidelines over there and makes a strong case generally for a prostate cancer screening programme. See the debate on Fox News here.

We commend Ben Stiller for sharing his experience of being diagnosed with prostate cancer. Thanks to a wise and informed clinician, he has been saved from joining the ever increasing ranks of men diagnosed with advanced and incurable prostate cancer, which is partly as a result of the continuing misinformation and negative publicity about the PSA Test. This is exemplified by the ill-informed recommendation from the US Preventative Services Task Force (USPTF) that the test should not be offered to asymptomatic men. Well-informed clinicians (such as Mr Stiller’s) wisely ignore this recommendation, but it still has great influence over those clinicians not expert in the field, or do not have the time to read up and understand this complex problem.

No man was ever harmed by knowing his PSA. The harm, if it comes, used to come from what clinicians do with the results. But the rush to invasive diagnosis and over-treatment common in the last century is rarer these days as an intelligent, informative and risk-based approach is adopted in most centres. Examples of this are increasing use of MRI before biopsy, and the adoption of Active Surveillance as a management regime for low risk disease. What is important to point out is that all these techniques depend on an initial PSA test.

If PSA testing of asymptomatic men were to be stopped (as the USPTF would wish) the vast majority of men who develop prostate cancer would present with later stages of the disease that has spread beyond the prostate, and in most cases they would die from it.

Chris Booth, a member of Tackle's Clinical Advisory Board, has been studying the results of the ProtectT trial and observes as follows:

Despite major advances in treatment over the 10 year course of this study, the death rate from prostate cancer (PCa) in the UK remains at a highly unsatisfactory 11,000 each year.

Over this time men with early stage, non-aggressive PCa and more than 10 years’ life expectancy have routinely been offered active surveillance as an alternative to radical surgery or radiotherapy. This trial has confirmed the safety of active surveillance.

Does the trial prove anything else or suggest changes in future practice? Undoubtedly!

All the men in the trial had PSA screening detected cancers. Over half initially on surveillance showed signs of progression and switched to radical treatment. Presumably, without screening in the first place, these men would have presented with late stage, incurable disease and most likely added to our PCa death toll. This progression rate is not surprising given the limitations on the accuracy of standard TRUS biopsies during the trial period 1999-2009. However, the results of the PROMIS trial of multiparametric MRI (mpMRI) now offers the hope of early recognition of significant cancer likely to progress whilst saving those with insignificant, non-aggressive cancers even the need for invasive biopsies; a major reduction in “over-diagnosis”. However, none of these benefits applies without PSA screening in the first place.

Does the trial have implications for PSA-based screening? Obviously!

Only 8% of eligible UK men undergo PSA screening compared with 60% in most Western countries. This alone probably contributes most to our high death rate. PROMIS and ProtecT now confirm that current UK clinical practice has both the tools and the method to avoid the twin bogies of screening – “over-diagnosis” and “over-treatment”.

Given that organised screening trials in Europe are delivering a 40-50% drop in mortality from PCa, we should surely now put our efforts into increasing our lamentable screening rate if we are to reduce our death rate. Indeed, with all the main urological associations worldwide supporting appropriate PSA-based screening and in the face of all this new evidence, it is simply not good enough for Dr Anne Mackie of the UK National Screening Committee to continue to trot out the mantra that PSA screening in the UK today “would do more harm than good”. Where is the proof of that against all this new evidence?

Save a Dad!Friday, 16th September 2016

Tackle Chairman Roger Wotton has welcomed a new initiative called "Save a Dad!" by Tackle member Leighton Hospital Support Group together with a school in Crewe and commented "Who can argue with “Save a Dad!” It is encouraging to see the next generation learning about prostate cancer. Kids talking to dads is another way of raising awareness! We really hope that this could become something that every school in the country would get involved with as it would dovetail well with Tackle's campaign to "get a score on the board"."

The National Institute for Health Care Excellence (NICE) today publishes draft guidance for life-extending drug, Xofigo® (radium-223 dichloride) now allowed for men with castration-resistant prostate cancer, symptomatic bone metastases and no known visceral metastases where docetaxel is contraindicated or is not suitable. Due to Tackle’s help in campaigning throughout the approval process, this medicine is now made available to a larger group of men who have not taken docetaxel and for men in Wales who aren’t suitable for docetaxel.

Hugh Gunn, Trustee, commented: “Tackle Prostate Cancer is delighted that NICE have relaxed the ruling on Radium-223, which was only previously available to patients who had already received the chemotherapy drug docetaxel. NICE have announced today that it can now be given to patients irrespective of whether they have received docetaxel, providing there is no visceral (soft tissue) metastasis.

This is a welcome and sensible improvement that Tackle has worked hard to achieve and it will greatly benefit prostate cancer patients who have limited treatment options open to them.”

Tackle successfully continues to campaign, making more medicines available for prostate cancer patients, giving vital lifelines to men with limited treatment options.

Urologists commit to introduction of MRI scans before biopsyFriday, 5th August 2016

At the annual conference of the British Association of Urological Surgeons' (BAUS) annual conference in June, Prostate Cancer UK reports that there was agreement "mpMRI could benefit men and want to see it happen, agreeing this needs to be in a controlled and consistent manner. It was also great... to receive a commitment from BAUS and the urologist community ... in making sure that roll out of pre-biopsy mp-MRI is made possible within the correct parameters".

Tackle has been at the forefront of calling for MRI scans before biopsy. As one delegate commented at our conference in June this year to great applause: "Biopsy without MRI is butchery".

Cancer Drugs Fund - the latestTuesday, 2nd August 2016

According to the NHS, the latest changes to the Cancer Drugs Fund (CDF) will "provide patients with faster access to the most promising new cancer treatments". Most existing prostate cancer treatments are already included - and Tackle has been at the forefront of campaigning on your behalf to ensure they are.

Sounds promising! But the NHS have only a finite amount of money available. Concerns have been expressed that pharmaceutical companies have been overcharging and, in order to try to prevent this occurring, the NHS plans to offer "those pharmaceutical companies that are willing to price their products responsibly, a new fast-track route to NHS funding for the best and most promising drugs via an accelerated NICE appraisal process and a new CDF managed access scheme".

What this means in practice, therefore, is that if the NHS can't reach agreement with a pharma company on price, the drug/treatment won't be approved and patients will lose out.

Whilst we understand that finances are limited, we urge NHS to put patients first and prevent unnecessary suffering.

You can read the full NHS England document about how the CDF will operate here.

Latest Surveys Reveal both Good News and Bad News about Prostate CancerThursday, 21st July 2016

First, the bad news from two recent studies. Prostate Cancer (PCa) remains the commonest cancer in UK men with 47,000 new registrations each year and it is the second commonest cause of cancer deaths at 11,000 each year. Despite this a new survey conducted by the charity Prostate Cancer UK confirms that British men remain amazingly ignorant of this potential threat. It showed that of 1,900 men questioned, 17% had never even heard of the prostate, 54% didn’t know where it was and 92% didn’t know what it did! Couple this to a generally negative view of PCa screening held by many GPs and it helps explain why our death rate from PCa is poor compared with similar western countries.

A second worrying statistic from a new Northwestern Medicine study in the USA reports a national 72% rise in new cases presenting with advanced, incurable, metastatic PCa from 2004-13 with the largest increase in 55-69 year olds. This is exactly the age group for whom there is an international consensus that Prostate Specific Antigen (PSA) screening should be targeted.

Over the past decade in the USA there has been a substantial reduction in the number of men screened and the number of new cases has declined. Though this alarming trend may not be solely down to lack of screening, it is clearly a major contributory factor.

The good news is that the latest screening trial results from Europe are showing that if you are in an organised PCa screening programme using the blood test PSA from your 50s onwards, you can cut your risk of death from PCa by 40-50%. Furthermore, if you do have an abnormal PSA, increasing use of MRI scanning before invasive prostate biopsies greatly improves our ability to decide whether a biopsy is necessary and if it is, greatly improves the accuracy of the procedure. This leads on to an avoidance of unnecessary treatment for many harmless cancers and ensures better identification for early curative treatment for the dangerous ones.

There is more good news for men diagnosed with PCa. Many such patients ask what they themselves can do to help combat the cancer. There is some evidence to suggest certain diets may help but nothing else till now. A research team from Atlanta, Georgia, led by Dr Ying Wang has shown that in 10,000 men with PCa that had apparently not spread elsewhere at the time of diagnosis, exercise reduced subsequent PCa mortality. Those doing more than 17 hours exercise per week before their diagnosis reduced their chance of death from PCa by 30%. Also, very encouragingly, a 34% reduction occurred in men who only started to exercise after their PCa had been diagnosed! Walking was the main type of exercise but the maximum benefit was seen in men with a varied exercise regime such as gym work and swimming.

All this information continues to point to the need for UK men to become much more aware much earlier about what can go wrong in the future. It also means our GPs, upon whom PCa screening depends, need to be supplied with up to date evidence from trials and best clinical practice so that they can provide sound counselling and allow their patients to make informed decisions for their future health.

NB: If you have a family history of PCa or breast cancer on your mother’s side OR if you are a black African or African Caribbean man, you may have a much higher risk of PCa and need to discuss being in a screening programme.